布托啡诺复合氟比洛芬酯用于腹腔镜术后镇痛效果观察

目的 观察布托啡诺复合氟比洛芬酯用于普外科腹腔镜手术术后镇痛的效果。方法 60 例ASAⅠ~Ⅱ级的普外科腹腔镜手术患者,随机分为两组,每组30例行病人静脉自控镇痛（PCIA）。布托啡诺组（B组）单纯使用布托啡诺行PCIA,布托啡诺复合氟比洛芬酯组（BF组）除使用布托啡诺PCIA外,分别在手术结束时和手术后24 h静脉给予氟比洛芬酯50 mg。观察并记录术后2、6、12、24、48 h患者的生命体征、镇痛（VAS评分）和镇静（Ramsay评分）效果、各时间段有效按压次数、布托啡诺用药总量和不良反应情况。结果 两组各时间点的VAS评分无统计学差异;术后6、12 h时,BF组的镇静评分低于B组;术后2、6、12、24 h等时间段,BF组有效按压次数少于B组;BF组布托啡诺用药总量少于B组;两组不良反应无差异。结论 两种PCIA方法均可用于普外科腹腔镜术后镇痛,而布托啡诺与氟比洛芬酯使用可以减少布托啡诺的用量和相关的不良反应,值得提倡。     

布托啡诺与芬太尼用于剖宫产术后镇痛效果的对照研究

目的 观察比较布托啡诺与芬太尼及其给药方式用于剖宫产术后镇痛效果、镇静作用、不良反应及患者舒适度等.方法 将80例剖宫产妇随机分成4组,每组20例,A、B组分别给予布托啡诺静脉自控镇痛(PCIA)及硬膜外自控镇痛(PCEA),C、D组分别给予芬太尼PCIA及PCEA.观察各组患者术后不同时间点生命体征检测及不良反应发生情况,并进行双盲镇痛评分(VAS)、镇静评分(Ramesy评分)、舒适度评分(BCS).结果 芬太尼与布托啡诺术后1 h镇痛效果比较,差异显著(P＜0.05);布托啡诺PCIA术后6、12 h BCS较PCEA高,差异显著(P＜0.05);4组患者术后生命体征监测指标、Ramesy评分及不良反应的发生情况差异均无统计学意义(P＞0.05).术后24 h各组VAS基本相似(P＞0.05).结论 芬太尼较布托啡诺用于剖官产术后镇痛,术后1 h镇痛效果更佳,术后12 h内舒适度更好.PCIA方式较PCEA方式镇痛效果亦更佳.剖宫产术后镇痛应首选芬太尼PCIA.     

酒石酸布托啡诺联合芬太尼用于全髋置换术后静脉自控镇痛的临床观察

目的:观察酒石酸布托啡诺联合芬太尼用于全髋置换术后静脉自控镇痛(PCIA)的效果和安全性。方法:选择ASAⅠ～Ⅱ级行全全髋置换患者60例,随机均分为A、B2组。术毕PCIA为A组:芬太尼1.0mg,B组为芬太尼0.5mg,酒石酸布托啡诺4mg;镇痛泵药物均用生理盐水稀释至100mL。记录术后4,8,24,36小时的视觉疼痛模拟评分(VAS)、Ramsay镇静评分、PCIA按压次数及不良反应。结果:术后PCIA按压次数与各时点的VAS2组间差异均无统计学意义。B组Ramsay镇静评分及恶心、呕吐发生率低于A组(P<0.05)。结论:酒石酸布托啡诺联合芬太尼用于全髋置换术后静脉自控镇痛的效果良好,且能减少芬太尼用量,同时降低不良反应的发生。     

布托啡诺、芬太尼联合治疗术后患者自控静脉镇痛的临床疗效观察

目的比较布托啡诺、芬太尼、布托啡诺联合芬太尼用于术后患者自控静脉镇痛(PCIA)的临床效果.方法 60例ASAⅠ～Ⅱ级的腹部手术患者,随机均分为布托啡诺组(B组)、芬太尼组(F组)、布托啡诺联合芬太尼组(BF组),术毕按3种方案实行PCIA.记录并比较术后2、4、8、18、24、48 h的疼痛视觉模拟评分(VAS)、Ramsay镇静评分及不良反应.结果 3组患者均达到了良好的镇痛效果,但术后8 h、18 h、24 h,BF组的VAS评分明显低于B组(P<0.05).B组术后4、8、18、24 h的Ramsay镇静评分明显高于F组(P<0.05).B组头晕发生率高于F组(P<0.05);BF组呕吐发生率低于F组(P<0.05).结论布托啡诺联合芬太尼用于术后镇痛效果确切,不良反应少,是一种较理想的术后镇痛方法.     

布托啡诺及芬太尼单独和联合应用于子宫全切术后PCIA效果观察

目的 观察布托啡诺、芬太尼分别及联合应用于子宫全切术后自控静脉镇痛(PCIA)临床效果.方法 选择该院2007年1月至2009年1月择期行妇科子宫全切除术患者213例,随机分为3组,A组:芬太尼组;B组:布托啡诺组;C组:布托啡诺联合芬太尼组.对患者2、4、8、12、24、48 h使用情况进行随访,观察并记录患者各时点镇痛效果、镇静程度、镇痛期间的进药量、应用肌内注射盐酸哌替啶次数、患者自控输注次数、不良反应等,以及镇痛治疗结束后分析患者总体满意度.结果 3组各时间点镇痛、镇静效果满意,差异无统计学意义(P>0.05),均未发生呼吸抑制,不良反应发生率,C组低于A、B组,3组患者因PCIA效果不好,加用肌内注射盐酸哌替啶次数无差异,48 h后随访满意度相同.结论 布托啡诺联合芬太尼在子宫全切术后PCIA应用中总体效果优于单纯布托啡诺、芬太尼,值得临床推广.     

布托啡诺和芬太尼用于冠脉搭桥术后镇痛的比较

目的比较布托啡诺与芬太尼用于冠脉搭桥术后静脉镇痛的疗效及不良反应。方法40例行心脏非体外循环冠脉搭桥术的病人,术后随机分入B组和F组,分别接受布托啡诺和芬太尼的病人自控静脉镇痛（PCIA）治疗。比较两组患者拔管后各时段桡动脉平均动脉压（MAP）、8PO2、疼痛程度的视觉模拟评分（VAS）、Ramesay镇静评分．以及按压镇痛泵的次数和不良反应发生率等指标。结果两组各时段的MAP、8P02、VA8评分差异均无统计学意义（P〉0．05）;B组的镇静评分显著低于F组（P〈0.05）;而按压镇痛泵的次数和不良反应的发生率明显低于F组（P〈0．01）。结论布托啡诺用于心脏冠脉搭桥术后静脉镇痛可取得满意的镇痛效果,不良反应较少,安全可靠,优于芬太尼静脉镇痛。     

腹腔镜胆囊切除术后布托啡诺与芬太尼静脉自控镇痛的比较

目的 比较布托啡诺与芬太尼术后静脉自控镇痛(PCIA)的效果及不良反应.方法 将100例腹腔镜胆囊切除全身麻醉患者按随机数字表法分为2组:布托啡喏组(n=50,B组),术后使用布托啡喏0.2 mg·kg-1,PCIA;芬太尼组(n=50,F组),使用芬太尼0.015 mg·kg-1,PCIA.比较术后48 h内疼痛视觉模拟评分(VAS),Ramsag镇静评分及不良反应.结果 2组术后VAs比较差异无统计学意义.B组术后Ramsay镇静评分明显高于F组(P＜0.05),但24 h后差异无统计学意义.B组术后恶心、呕吐发生率明显低于F组(P＜0.05).结论 布托啡诺在腹腔镜胆囊切除术后镇痛效果可靠,镇静效果优于芬太尼,可作为术后静脉镇痛的选择之一.     

布托啡诺复合舒芬太尼用于老年患者术后镇痛的观察

目的:比较单纯用布托啡诺、舒芬太尼和布托啡诺复合舒芬太尼在老年患者术后静脉自控镇痛(PCIA)的临床效果。方法:60例ASAⅡ～Ⅲ级老年患者行腹部及下肢手术患者,均采用气管插管静脉复合术,分为布托啡诺组(B组)、舒芬太尼组(S组)和布托啡诺复合舒芬太尼组(BS组),每组20例。术毕按三种方案实行PCIA,观察在PCIA开始后3 h、6 h、12 h、24 h、48 h记录镇痛、镇静效果,患者PCIA的给药次数和不良反应情况。结果:三组PCIA方案均能达到良好镇痛和镇静的目的,但B组的疼痛视觉评分高于S组和BS组(P<0.05),且BS组不良反应发生率较低,患者满意度更高。结论:联合用药的BS组,由于药物间的协同作用,镇痛效果佳,不良反应发生少,患者满意度高,布托啡诺复合舒芬太尼是一种较理想的老年患者术后镇痛方法。     

布托啡诺复合舒芬太尼用于脊柱外科术后静脉镇痛的临床观察

目的观察脊柱外科术后布托啡诺复合舒芬太尼用于病人自控静脉镇痛(PCIA)的效果和副作用。方法选择腰椎间盘突出症行手术治疗的患者80例,随机分为单纯舒芬太尼组(S组n=40),舒芬太尼1.75μg/kg+盐酸格拉司琼3mg+生理盐水稀释至100ml;布托啡诺复合组(B组n=40),布托啡诺0.1mg/kg+舒芬太尼1μg/kg+盐酸格拉司琼3mg+生理盐水稀释至100ml;两组病人均在全麻下手术,手术结束前15min接静脉PCIA泵行术后镇痛治疗。分别记录术后4、8、12、20、24和48hVAS疼痛评分、Ramsay镇静评分及并发症发生率。结果两组患者术后各时点VAS评分比较,差异无统计学意义(P>0.05);B组Ramsay镇静评分明显高于S组(P<0.05),B组恶心呕吐、呼吸抑制并发症少于S组(P<0.01)。结论布托啡诺复合舒芬太尼用于脊柱外科术后静脉镇痛效果确切,不良反应发生率更低。     

布托啡诺用于妇科手术术后自控静脉镇痛的临床研究

目的观察布托啡诺用于妇科手术术后自控静脉镇痛(PCIA)的临床效果.方法120例妇科手术患者,随机分为布托啡诺组(B组)和舒芬太尼(S组).B组用布托啡诺0.15mg/kg+生理盐水至100ml;S组选用舒芬太尼100μg+生理盐水至100ml.均采用PCA泵(100ml)以LCP模式(负荷剂量3ml+持续剂量2ml/h+PCA每次0.5ml)进行镇痛.观察术后1、4、8、24、48h患者VAS评分、Ramsay镇静评分,镇痛泵有效按压次数和不良反应发生情况.结果 B组与S组综合镇痛质量差异无统计学意义;B组皮肤瘙痒、嗜睡、呼吸抑制等发生率显著低于S组(P<0.01).结论 布托啡诺、舒芬太尼PCIA用于妇科手术术后镇痛均可获满意效果,但布托啡诺不良反应更少.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.